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Health Exchange Activity Heats Up As Deadline Approaches

There's nothing quite like a deadline to focus the mind. Even a deadline that's not quite real.

Friday was originally the day that states were supposed to not only tell the federal government whether or not they planned to run their own health exchanges, but also how they planned to do it.

Last week, however, the feds extended that deadline. Now states only have to say yay or nay by Friday on the issue of running their own exchange. If they want to partner with the federal government, they can wait until as late as next February to speak up.

And no matter what, if states fail to act, the federal government will set up an exchange in that state for them.

Still, flimsy or not, Friday's deadline prompted considerable activity this week from states who had been waiting to see what impact last week's election might have on the Affordable Care Act. (Answer: Full speed ahead.)

Thursday afternoon alone, three governors South Carolina Republican Nikki Haley, Nebraska Republican Dave Heineman and outgoing North Carolina Democrat Bev Perdue all announced their decisions. The Republicans said they would not be pursuing exchanges in their states; Perdue said North Carolina would likely pursue the partnership model, a hybrid state-federal exchange.

Haley announced her decision in a letter to Health and Human Services Secretary Kathleen Sebelius. "The law fails to give South Carolina any flexibility and decision-making authority that would enable us to truly construct the program in a manner that would offer the most meaningful benefit to our citizens," Haley wrote.

Nebraska's Heineman echoed those sentiments. "The reality is that the federal health care law is being totally dictated and totally controlled by the federal government," he said in a statement.

Heineman also said that building the exchange would cost the state too much money, even though federal funds are available to offset those costs.

In Indiana, Gov.-elect Mike Pence, currently a Republican member of the U.S. House, sent a letter to outgoing Gov. Mitch Daniels, also a Republican, urging that the state not establish its own exchange.

Some governors who previously said they would not participate are reaffirming those decisions, including Texas Republican Rick Perry. His spokeswoman told the Texas Tribune today that the state won't design its own exchange because there is "really no such thing as a 'state exchange.'"

But others appear to be changing their tune, most notably Rick Scott, Florida's Republican governor. After vowing to have no part of the health law, Scott earlier this week told the Associated Press he wants "to get to yes" and is ready to negotiate with federal officials.

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